address editor in chief co-editors secretary editorial board

JURNALUL PEDIATRULUI – Year XV, X
, Vol. XV, Nr. 59-60
60, , july
j
uly-december 2012
ECHOGRAPHIC FOLLOW-UP OF REFLUX STATUS IN A
CHILD WITH NEUROGENIC BLADDER AND
INTERMITTENT VESICAL CATHETERIZATION
Camelia Daescu 1,2 , Adela Chirita Emandi 1,2 , C Popoiu 1,2 ,
A Craciun 1,2 , Andreea Militaru 1,2 , Oana Belei 1,2
Abstract
Objectives: We highlight the role of echography in the
follow-up of an 8 year old girl with neurogenic bladder,
right megaureter due to reflux; left obstructive megaureter,
and impaired renal function.
Methods: The patient came quarterly to follow-up, to
evaluate renal function and possible infections, while the
hydronephrosis was evaluated by echography. She had
intermittent vesical catheterization and antibiotic
prophylaxis.
Results: The girl was diagnosed at 3 months of age
with complex renal malformation, one month later she
underwent bilateral cutaneous ureterostomy. Ureteral
reimplantation surgery was performed at the age of 1 year
and 6 months. At age 6, abdominal echography revealed
bilateral hidronephrosis grade IV, which was sustained by
uroMRI and stage 2 renal failure shown by renal function
tests. Intermittent vesical catheterization 4 times/day and
antibiotic prophylaxis were initiated. The echographic
follow-up reported that the reflux remained mostly
unchanged: left kidney had hydronephosis grade III, and the
right kidney presented hydronephosis grade III/IV.
Nevertheless the parenchymatous index increased, which
correlates with the improved renal function, from stage 2
renal failure (moderate reduction in glomerular filtration
rate=58mL/min/1.73m2) to normal glomerular filtration
rate. The blood urea nitrogen and creatinine levels slightly
decreased. The urinary tract infection rate remained low.
Conclusions: Long-term intermittent catheterization as
method of treatment and prevention is associated with stable
reflux status, renal function, and infection rate, which in the
end result in better quality of life for the patient.
Echographic method of follow-up is reliable for medical
examinations since it is informative, harmless and
economical.
Key words: Echographic follow-up; child; intermittent
vesical catheterization
Background
The urinary complications of patients with a
neuropathic bladder consist of incontinence, inability to
empty the bladder, urinary infection, and deterioration of the
upper urinary tract. Intermittent self-catheterization (ISC) or
carer/nurse-assisted clinically clean intermittent
catheterization (CIC) has developed over the past 30 years
as a means of treating patients with bladder-emptying
problems. It is now recognized as one of the safest methods
of managing patients, especially those with neurogenic
bladder disorders (1). CIC has been demonstrated to reduce
infection hazards and greatly improve the lives of many
patients with micturition disorders. In 1972, Lapides et al
(2) reported the successful treatment of neuropathic bladders
with CIC and since then CIC has become widely accepted as
the main therapeutic management for patients with such
bladders. CIC can be undertaken by health professionals in a
variety of clinical settings for a range of clinical indications,
and increasingly by patients themselves who use it as a
long-term bladder management technique. The relative
simplicity of the technique comes with the potential for
health professionals to underestimate the skills required
when considering a regimen of intermittent catheterisation
and, perhaps more importantly, to underestimate the impact
it may have on individual patients (3). Adequate bladder
emptying can be achieved by CIC, but urinary incontinence
may persist in the presence of detrusor hyperreflexia and/or
low compliance bladder.
Objectives
To highlight the role of echography in the follow-up of
an 8 year old girl with neurogenic bladder, right megaureter
due to reflux; left obstructive megaureter, and impaired
renal function.
Case report
History
We present an 8 years old girl that we have in
management, in the Nephrology department of Emergency
Hospital for Children “Louis Turcanu” in Timisoara. The
child is the first born of healthy non-consanguineous
parents. There was no family history of similar symptoms.
1 University of Medicine and Pharmacy “Victor Babes” Timisoara
2 Emergency Hospital for Children “Louis Turcanu” Timisoara
E-mail: camidaescu@yahoo.com, adela.chirita@yahoo.com, mcpopoiu@yahoo.com, ad_craciun@yahoo.co.uk,
andreamilitaru@yahoo.com, oana22_99@yahoo.com
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